Non-diabetes question: Immune hemolytic anemia

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Shiloh & Rhonda (GA)

Shiloh & Rhonda (GA)

Member Since 2015
My sister has a cat that wandered up to her house about three years ago. She has been feeding several stray cats for years, she is the neighborhood cat lady.

Anyway, about three months ago, the cat was curled up behind one of the wheels of her vehicle. My sister tried to move the car, felt some resistance and stopped. She got out of her vehicle and the cat ran off. My sister didn't think anything much about it, but then later the cat didn't come to greet her when she got back home. She found the cat and she wasn't acting right. Long story short, my sister had partially run over the cat, split her abdominal muscle and only her skin was holding her insides in. She had surgery done and she has been fine.

Fast forward to today. The cat, Honey, hasn't eaten for the last couple of days. My sister found her under the house not really wanting to move. She took her the vet and they told her that she is suffering from Immune mediated hemolytic anemia. Steroid therapy, cerenia, and see how she is in couple days. She is not sure what the blood level was called, but it was at 19%, 16% requiring a blood transfusion. Is there anything else that I can advise her to do?
 
Sorry to say, but for that ran over, she has internal bleedings since then. Did this last vet even do X-ray's now for that?
Red Blood Cells are called Hemoglobulin.
But that doesn't matter, all other things sips out too, as all Blood Proteins, Albumin e.t.c.

In Anatomy, see all pictures including x-rays on this link https://www.kestrel.ws/erasmus/education_pictures.html


cat-internal_anatomy_01.png




X-rays are needed for internal bleedings.
As long as those are bleeding inside, anyone will slowly die.
 
Hi Rhonda,

Shiloh & Rhonda (GA) said:
She is not sure what the blood level was called, but it was at 19%, 16% requiring a blood transfusion.
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That would be the haematocrit value (HCT), the percentage of red cells in the blood. They can be low in cats with anaemia, but the anaemia itself is typically a manifestation of the effects of a different problem, and there are several things that can cause it.

Helen has an excellent Anaemia primer up on Tanya's Site:

All about anaemia

It touches on all manner of causes of anaemia, including immune-mediated haemolytic anaemia (IMHA).

Here's another vet journal article on the subject which includes info on differential diagnosis of anaemias:

https://todaysveterinarypractice.com/immune-mediated-hemolytic-anemia/

I've got my sleep meds on board and I've got my eyelids held up with metaphorical matchsticks so can't do much digging for you tonight, Rhonda. Is there any chance you could post any other info the two of you have available, especially any other clinical signs on presentation (e.g. jaundice) and the results of any tests and/or diagnostic procedures the vet has run in order to give the differential diagnosis of IMHA would be helpful. I'll come back and look at this again tomorrow for you.

If there's a treatable condition at the root of the anaemia and the anaemia itself is still regenerative then with very prompt treatment of the underlying condition causing the anaemia can help restore HCT levels.

Sorry I can't do much just now. I'll catch up with you tomorrow.

:bighug:


Mogs
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Ann & Scatcats said:
Did this last vet even do X-ray's now for that?
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No, they didn't do x-rays. In fact, the initial "diagnosis" was liver failure, and they concluded that without even doing blood work. They only did the blood work after my sister insisted.

Critter Mom said:
especially any other clinical signs on presentation (e.g. jaundice) and the results of any tests and/or diagnostic procedures the vet has run in order to give the differential diagnosis of IMHA would be helpfu
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The only tests they ran were a CBC, after my sister insisted, and a test for parasites. Negative for parasites. I believe she said there was jaundice, but I will check with sister again to be sure.
 
@Shiloh & Rhonda (GA) -

I suggest showing your sister the link I sent you in my previous post. There's a diagram in it which shows the appropriate diagnostic steps needed to arrive at a diagnosis of IMHA. Perhaps it might aid her in discussions with her vet.

There is also helpful information here about jaundice (icterus) and underlying problems that may cause it:

Diagnosis and Treatment of Jaundice in Cats

The above link also has info on additional supplements that may be given to support the liver. (I used to give Saoirse Samylin. Like Denamarin, it has SAM-e and silybin, but it also contains vitamin C and vitamin E which, like silybin, have anti-oxidant properties.)

Also mentioned in the linked article is something called a Coombs test which apparently can determine whether the cause of the haemolysis is actually due to an autoimmune problem:

Coombs test

Just throwing an idea out here, but B complex supplementation can help CKD cats with anaemia (and appetite issues). While the transfusion might be necessary because Honey's haematocrit is so low at the moment, following on from that perhaps it might be something to enquire about with the vet. (If it was me in the situation I'd want the vet's confirmation before introducing any supplements, including vitamins.)

Tanya's Site - B Vitamins

I can't think of anything more to suggest other than looking at the above materials and asking the vet about relevant diagnostics and treatments for both the liver issue and the anaemia. I hope that Honey will feel better soon.

(((Honey)))


Mogs
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PS: If you know where the file is stored on the phone you could also try using drag and drop to move it into the Reply box.


Mogs
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Great Work! Even if I can see the at large general parameters, it is all just too too blurry and mini small even when I try to pinch enlarge it.

Either you have to write it all by hand, or if it's on link
 
Can't read the uploaded image - even tried enlarging it on my tablet but the resolution of the image is too low and it goes blurry. Any chance you could try uploading a higher res image, Rhonda?


Mogs
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Rhonda, the kidney values are not high enough to normally cause the anemia. The neuts are high. I suspect the cause is not kidney related. I don’t think it’s nonregenerative anemia. We have a. At here that had this happen. He was hospitalized more than once and had transfusions. So far he is doing well and back to normal.
 
Shiloh & Rhonda (GA) said:
Elise, I saw the Bilirubin is off the charts. What would cause that part of it?
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Was a thyroid panel run? Could be hyper-t but it’s also another liver marker and you said he’s jaundice. The jaundice can be due to fatty liver.and the bilirubin would be from that. Did he lose a lot of weight quickly? The cat here that had this was told it could be kidney but also might not be. Same thing in that kidney markers were not high.
 
What I posted was all the results the vet sent my sister, so I assume no thyroid panel was run. My sister was not happy at all with this vet clinic. It was kind of an only choice situation. I don't think she's lost weight. My sister has been through so much this past year with our mother, her husband, the accident with this cat...I just don't know how much more she can take.
 
I’m so sorry to hear that. @Yuling & Casper does this sound like Casper? It does to me.

A full thyroid panel might not be needed. I was just wondering if T4 has been done. I don’t think I saw it.
 
For those following this, my sister is taking Honey to the emergency vet tonight. She has not improved noticeably with the steroids, and is still not really eating. Will keep you all updated. Thanks for your good wishes up to now.
 
tiffmaxee said:
I’m so sorry to hear that. @Yuling & Casper does this sound like Casper? It does to me.

A full thyroid panel might not be needed. I was just wondering if T4 has been done. I don’t think I saw it.
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Sorry to get back to all of you late, I was pretty much living in the bathroom all day and all night.
The Honey's symptoms sound like Casper, but not so much the same: She did not lose significant weight, Casper did at the time. Both HCT numbers are quite close, when Casper was admitted into ACCESS, his number was at 19.5, compares to hers at 19.3. Her phosphorus and potassium levels are in range, Casper's were off the chart. I can't really tell if she is in the same boat as Casper 2 months ago with my limited knowledge. I think your and Mogs assumption is correct, this anemia may not be kidney disease-related. Boo, my other cat who had kidney failure 2 months prior to Casper, also lost quite a lot of weight.
The blood transfusion does help if she is not getting an IV in the next few days to flush it thin again. Casper was sent home with low HCT and hemoglobin numbers, with Elise's helps, we started him on a daily B12/B9 complex supplement and did a 3-week B12 injection (0.25ML per week, once a week). If the cat doesn't eat by herself, you may try syringe feeding, we did use Cerenia and Mirtazapine for about 7-8 days to help him with nausea and encourage his appetite.
 
Still at the ER vet, IV fluids, antibiotics. Her hemocrit is down to 15%. The ER vet wants to see how she responds to the antibiotics but if the % gets any lower, she will be getting a blood transfusion later today.

ETA: Another blood smear done, still no sign of parasites, so they are thinking against bobcat fever at this point.
 
:nailbiting: (((Honey)))

Your sister has been through so much. These are for her: >>>>>> :bighug::bighug::bighug:

Do you know which antibiotic they're giving her, Rhonda? Have you heard any mention of mycoplasma at all? Have they done any scans/x-rays (e.g. spleen, bile duct)? Any mention of a Coombs test? (Sorry about all the questions. It's 'cause I care.)



Mogs
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Critter Mom said:
Do you know which antibiotic they're giving her, Rhonda? Have you heard any mention of mycoplasma at all? Have they done any scans (e.g. spleen)? Any mention of a Coombs test? (Sorry about all the questions. It's 'cause I care.)
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I don't know which antibiotic. She is going to check when they call later, along with whether or not they have done x-rays to check for any internal bleeding. No mention of mycoplasma, any scans or Coombs test. What is a Coombs test?
 
They said, given her current symptoms, if it was bobcat fever, they should be able to see it in the smear, but they don't see anything.

And my sister said thank you so much for the prayers and hugs. :)
 
Much brainstorming follows.

Shiloh & Rhonda (GA) said:
What is a Coombs test?
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Reposting the link from post #8 above:

Coombs Test

Apparently it's a test to determine whether the haemolytic anaemia is due to an autoimmune disorder. That said, according to the online Merck Veterinary Manual you can also get a positive Coombs test result if there is a mycoplasma infection. From the Merck manual:

The hemolysis caused by hemoplasma infections is typically extravascular and results in a regenerative anemia. Erythrocyte agglutination may be present, and Coombs’ test results are often positive in cats infected with [Mycoplasma] haemofelis.​

Do you know whether they have ruled out M. haemofelis? According to the Merck Manual it can cause acute haemolytic anaemia but sometimes the organisms don't show up on blood smears (can be picked up with PCR tests):

Historically, diagnosis has been made based on detection of organisms on routine Wright-stained blood smears, on which they appear as small (0.5–3 μm), basophilic, round, rod, or ring-shaped structures present on erythrocytes individually or in chains, or sometimes seen free in the background. However, parasitemia in chronic infections can be cyclic, and organisms can disappear from circulation in as little as 2 hr. In addition, hemoplasmas dissociate from erythrocytes and die after a variable amount of time in EDTA, hampering detection of organisms in aged samples. Recent development of sensitive PCR assays capable of discriminating between various hemoplasmas has greatly enhanced diagnosis of these parasites and has led to identification of several new Mycoplasma species.

[Emphasis mine]​

Also, do you know whether they have said whether the anaemia is regenerative? Any other news?

(((Honey and Sis)))

:bighug:


Mogs
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Slight off-topic:

For anyone following this thread, by way of board peer review this is just a note to clarify that red blood cells are not called "hemoglobulin" as erroneously posted above.

Mature red cells are most commonly referred to as erythrocytes. Immature red cells are called reticulocytes. [Ref]

Red blood cells contain haemoglobin (alternative spelling 'hemoglobin'), the substance that enables transport of oxygen from the lungs to the rest of the body.

Wikipedia has no entry for 'hemoglobulin'. However, Wiktionary identifies it as a synonym for 'hemoglobin'.


Mogs
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Doxycycline is the antibiotic she is on. She is still about the same. Her hemacrit is holding at 15%. Still nothing on the blood smear. Fever is normal. Still not interested in eating so they are going to start the syringe feeding.
 
She is doing about as well as can be expected. She has decided, I think, that if it comes to blood transfusions, she will try one. But if she doesn't turn a corner, she probably won't put her through another. I am ok, but it just kills me not to be able to physically be there for her.

Thank you so much for asking!
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What makes it super hard for my sister is that Honey, unlike my pain in the ass Sassy, is very much a people cat. She loves my sister like nobody's business, and she can't be with her.
 
Shiloh & Rhonda (GA) said:
She has decided, I think, that if it comes to blood transfusions, she will try one.
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If it is an infection of some kind causing the haemolysis then the transfusion would hopefully buy time for the treatment to work.

Shiloh & Rhonda (GA) said:
it just kills me not to be able to physically be there for her.
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Shiloh & Rhonda (GA) said:
[Honey] loves my sister like nobody's business, and she can't be with her.
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This is one of the very worst aspects of the pandemic: not being able to be with those we love when they need us. :( I've been thinking all day about poor Honey being in the hospital with no visits from her mama, and all the while her mama is itching to be beside her. I can sense how worried you are too - for both of them. The whole situation sucks to the high heavens. :(

(((Rhonda, Sis and Honey)))


iu



Wish there was something I could do to help.


Mogs
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Critter Mom said:
I've been thinking all day about poor Honey being in the hospital with no visits from her mama
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And the ER vet is 75 miles from where my sister lives. She is contemplating taken her to the University of Missouri at Columbia Vet Clinic. She had her Big Red treated there for stomatitis, and my mom had her dachshund Laverne's back surgery.
 
Hemacrit dropped to 12%. Doing the blood transfusion. The vet told her that blood transfusion isn't curing anything, just buying time for the meds to work. Will see what the morning brings.
 
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